Healthcare Provider Details

I. General information

NPI: 1265592232
Provider Name (Legal Business Name): MONTOYA FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8451 E PAWNEE ST
WICHITA KS
67207-5420
US

IV. Provider business mailing address

8451 E PAWNEE ST
WICHITA KS
67207-5420
US

V. Phone/Fax

Practice location:
  • Phone: 316-618-0035
  • Fax: 316-618-0010
Mailing address:
  • Phone: 316-618-0035
  • Fax: 316-618-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0429228
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00731
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45218
License Number StateKS

VIII. Authorized Official

Name: DR. NATALIA MONTOYA
Title or Position: OWNER
Credential: M.D.
Phone: 316-618-0035